- Enrollment id
- O20170710001885
- Enrollment state
- TX
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1922418631
- Multiple npi flag
- N
- Ccn
- 675754
- Associate id
- 5395786180
- Organization name
- NOCONA HOSPITAL DISTRICT
- Doing business as name
- TRAYMORE NURSING CENTER
- Organization type structure
- OTHER
- Organization other type text
- HOSPITAL DISTRICT
- Proprietary nonprofit
- N
- Nursing home provider name
- TRAYMORE NURSING CENTER
- Affiliation entity name
- FOURSQUARE HEALTHCARE
- Affiliation entity id
- 226
- Address line 1
- 4315 HOPKINS AVE
- City
- DALLAS
- State
- TX
- Zip code
- 752093026